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Aim To test whether titanium-zirconium (TiZr) 3.3 mm diameter implants perform differently from titanium (Ti) 4.1 mm diameter implants with respect to marginal bone level (MBL) and clinical parameters. Material and Methods Forty subjects in need of a single implant-supported crown in the anterior or premolar regions were recruited in two centres. After random allocation, either a Ti or a TiZr implant was placed. Definitive crowns were inserted 6 months after implant placement. Implant survival, change in MBL, clinical parameters and occurrence of adverse events were assessed at the 1-year examination. Results At 1 year, 38 of the 40 included patients were examined (18 Ti and 20 TiZr implants). All the implants were in place and stable. From the implant placement to the 1-year examination, the change of MBL amounted to −0.40 mm in the Ti group and −0.41 mm in the TiZr group. There were no significant differences between the groups regarding the change in MBL, the clinical parameters and the occurrence of adverse events. Conclusions The use of TiZr implants with narrow diameter for the support of single crowns in the anterior and premolar regions leads to successful tissue integration and clinical performance over a 1-year period. [ABSTRACT FROM AUTHOR]